Day the phone lines went crazy
When the control room staff came to work at the East Midlands Ambulance Service on the morning of 3 January this year, they could not have known what was about to happen.
The phone lines went crazy. During the course of the cold winter's day, they received 45% more emergency calls than on the same day the previous year.
The result? Long delays at the regions 23 A&E units.
If the queues that developed during that day were placed end to end they would have stretched 1.6 miles (2.6km).
Phil Milligan, chief executive of the East Midlands service, said: "There is not much you can do when that happens and that, of course, affects your ability to respond to calls. You gear up for a normal day, but when the unexpected happens you have to do your best."
The problem is that 3 January is in some ways not unique.
The surge in calls seen on that day was the highest the service had seen in a long time, but it is part of a continuing rise in demand for ambulance crews.
Over the past year, the number of calls made to East Midlands has risen by more than 4% to 723,000, according to the NHS Information Centre.
The trend has also coincided with a rise in the number of patients who wait longer than the recommended 15 minutes for handover from paramedics to staff when they arrive at hospital.
Over the past 12 months a third of patients ferried by the East Midlands service waited longer than they should - up from a quarter from the previous year.
It is a picture that is mirrored across the health service.
East Midlands has tried to tackle the issue head-on by introducing new systems. More phone assessments are now being done, allowing the service to channel patients who do not really need an ambulance to other parts of the health service.
On top of that the service has been running a pilot at some of the region's busiest hospitals where liaison officers are deployed to improve the handover of patients.
This has involved reviewing internal systems in the hospitals as well as being on hand to look after patients if the hospital is struggling to get to them so that paramedics can get back on the road.
But Mr Milligan believes measures such as these can only do so much.
He said it is going to be important to educate the public if ambulance services are going to be able to cope in the future.
"The public have a role in solving the problem. We need people to really think about whether they need an ambulance. Could they see a GP or go to a walk-in centre?
"The rise in calls is making it difficult for all of us. The health service is under tremendous pressure at the moment.
"It is tough. We are having to make savings and cope with increasing demand. It means the system is silting up... if we have another day like 3 January it is going to have an impact."